Kobe wrote:Did any of you get to the point where neuropathy went from tingling to losing motor function - loss of grip, dropping things, etc?
Once chemo ended did the tingling stop?
Kobe wrote:Did any of you get to the point where neuropathy went from tingling to losing motor function - loss of grip, dropping things, etc?
Once chemo ended did the tingling stop?
NHMike wrote:... I'm pre-surgery with Xeloda and am wondering what the dosage is post-surgery vs pre-surgery. If anyone is on XELOX or had it, perhaps they could do a mg comparison of post-surgery to pre-surgery...
Dosing
The ideal dosing of capecitabine is controversial ...
Capecitabine was initially approved at a dose of 2500 mg/m2 for 14 of every 21 days; however, this dose results in increased toxicity in the United States as outlined above. The most recent National Comprehensive Cancer Network guidelines recommend starting doses of 850 or 1000 mg/m2 twice daily when used with oxaliplatin for advanced or metastatic colorectal cancer (mCRC), while the group recommends using 1000–1250 mg/m2 twice daily when it is given as monotherapy. With concurrent radiation for rectal cancer, the recomended dose is 850 mg/m2 twice daily.
.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3097797/ 2011
andThe ideal dosing of capecitabine is controversial as regional differences have been seen in the tolerance of oral fluoropyrimidines [ . . . ]those enrolled in trials in the United States had higher rates of grade 3 and 4 adverse events (relative risk [RR], 1.77), an increase in the frequency of dose reduction (RR, 1.72), and higher rates of treatment discontinuation (RR, 1.83). The results [ . . ] in the adjuvant setting also showed increased grade 3 and 4 adverse events (RR, 1.47) and higher rates of discontinuation (RR, 2.09). On further analysis, East Asian patients fared the best overall.
A number of possible explanations for the variation in side effect profiles between countries have been proposed. Folic acid supplementation is much more widespread in the United States than in Europe which might account for a portion of the differences. Pharmacogenetics may also play a role as genetic differences between Caucasian and Japanese patients have been discovered, but this is unlikely to explain the variation in events between the United States and European populations who have similar genetic profiles.
In a 2009 article by Chu et al [ . . .] the mean predicted monthly complication cost was 136% greater with 5-FU monotherapy when compared to capecitabine. This equated to an additional US$601/month (95% CI: $469–$737) spent treating complications associated with 5-FU. When each agent was given in combination with oxaliplatin, this value increased to US$1165/month (95% CI: $892–$1595).
[ . . . ]
the X-ACT trial (capecitabine versus 5-FU in the adjuvant treatment of CRC) showed the cost of treating patients with capecitabine in the United Kingdom was 57% lower than that for 5-FU.61 Capecitabine use led to decreased hospitalization rates and cost savings of £3653. Societal costs for such things as patient travel and time off work were also lowered by £1318, again reinforcing the potential cost benefit of capecitabine.
[ . . . ]
trials NO16966 and NO16967 was also reported in 2009.62 In the analysis, the authors found the incremental improvement in quality-adjusted progression free survival days (QAPFSD) favored XELOX over FOLFOX4 in both first- and second-line settings. Specifically, patients gained 10.5 QAPFSD from first-line and 11.3 QAPFSD from second-line treatment. Cost calculations found savings for the National Health Service of £7600 and £3900 for patients treated with XELOX in first- and second-line settings, respectively.
[ . . . ]
a study published in the United States demonstrated a lower cost with capecitabine monotherapy when compared to 5-FU and leucovorin of US$6683 versus US$9304.63 It showed a higher acquisition cost for capecitabine but lower administration and complication costs. This held true when oxaliplatin was added to the regimens with costs of US$11,463 and US$14,320.
[ . . . ]
Overall, these studies demonstrate a measurable cost saving when using capecitabine in place of 5-FU.
Reimbursement policies vary internationally and even regionally within the United States. Multiple analyses have shown cost savings when capecitabine is compared to 5-FU, but variability in insurance coverage for oral cytotoxics can lead to significantly higher out-of-pocket expenses for patients, especially since 5-FU is usually fully covered by insurance plans.
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